Caring for children with COVID-19 in the community

General Practitioners play a vital role in managing paediatric patients with respiratory viral illnesses, including COVID-19.

Assessment of disease severity in children

If a child tests positive for COVID-19 and there is concern from carers, GPs are encouraged to perform a clinical assessment of disease severity and risk factors. This may be completed as a telehealth or face to face service as per resources available.

Please refer to National Clinical Evidence Taskforce COVID 19 Definition of Disease Severity.

Medical Risk Factors for progression to severe disease

  • Primary or acquired immunodeficiency e.g.:

    • Haematologic neoplasms: leukaemias, lymphomas, myelodysplastic syndromes, haematopoietic stem cell transplant (until immune recovery)
    • Post-transplant: solid organ (on immune-suppressive therapy)
    • Other significantly immunocompromising conditions
    • Immunosuppressive therapy (current or recent) including chemotherapy, high-dose corticosteroids (>0.5 mg/kg/day or >20 mg/day prednisolone, or equivalent) for more than 14 days. Most biologics and disease-modifying antirheumatic drugs (DMARDS).

  • Chronic lung disease:

    • CF (or bronchiectasis) with FEV1 <60%
    • Congenital tracheal stenosis
    • Chronic lung disease with O2 treatment
    • Pulmonary hypertension
    • Neuromuscular disease (with daytime respiratory support)
    • Tracheostomy with ventilation

  • Heart failure:

    • Cardiomyopathy (requiring diuretics)
    • Shunt-dependent pulmonary blood flow
    • Pulmonary hypertension (requiring PH-specific therapy)
    • Single ventricle

  • Severe asthma in the last 12 months:

    • ≥1 severe exacerbation requiring ICU admission or IV treatment
    • OR ≥2 hospital admissions
    • OR ≥2 exacerbations requiring treatment with oral corticosteroids
    • OR child requires treatment with biologic to control asthma

  • Complex life limiting neurodisability with respiratory involvement

  • Diabetes (insulin-dependent)

  • Obesity (BMI≥95th [CDC] / ≥97th [WHO] centile for age)

  • Chronic kidney disease

  • Sickle cell disease

  • Complex genetic disorders, including trisomy 21, metabolic disease, gastrointestinal or multiple congenital anomalies.

Caring for children with COVID in the community

Children aged under 18 years who are COVID positive with no or mild symptoms can generally be safely managed at home. Please refer to the National Clinical Evidence Taskforce Pathways to care for children and adolescents with COVID 19.

Low risk

If a child/adolescent is asymptomatic OR has mild symptoms/signs of severity with no risk factors for poor outcome (medical or social risk factors) the child will be managed as within the community at home with usual GP involvement in care and National Coronavirus Helpline support.

GPs can access advice from the SA Health COVID-19 Clinical Medical Advice Line, telephone: 1800 313 090.

Medium risk

If a child/adolescent has moderate clinical features OR medical risk factor/s and COVID-19 unvaccinated (immunocompromised children should be considered unvaccinated), consider referral to COVIDKids for escalation as required if meeting criteria.

GPs can access advice from the SA Health COVID-19 Clinical Medical Advice Line, telephone 1800 313 090.

High risk

If child/adolescent has severe/critical symptoms, they will require urgent face to face review at their closest Emergency Department/Women and Children Hospital Emergency Care. Call 000 for ambulance or mode of transport based on clinical scenario. All public emergency departments able to provide emergency services to children regardless of COVID status when not suitable for community or CAVUCS care.

COVIDKids

Management of medium-risk patients with mild-moderate symptoms or medical/social complexity may be supported by COVIDKids after GP referral.

Coordinated by specialist staff at Women’s and Children Hospital, COVIDKids is a dedicated clinician only referral service for children and young people with COVID-19 located anywhere in South Australia.

COVIDKids also assesses eligibility for, and coordinates provision of antiviral therapy to, children at high risk within the first 7 days of illness.

Referral information for the Women’s and Children’s Hospital

COVIDKids specialist virtual support service for complex paediatric COVID cases is now available. The site also has referral form templates compatible with major GP medical record software, designed to make the process of referring more efficient for clinicians in the community.

Child and Adolescents Virtual Urgent Care Service

Women’s and Children Hospital also offer a virtual assessment option, Child and Adolescents Virtual Urgent Care Service. This is an ED avoidance service to manage children requiring urgent review. It also provides same day clinical advice for GPs throughout South Australia for patients aged over 6 months and under 18 years who are acutely unwell.

Details including opening hours and referral process can be found at Child and Adolescent Virtual Care Service - for GPs.